Binswanger’s disease: symptoms, causes and treatment of this dementia

Dementias involve the loss of brain function and are caused by multiple causes and diseases. They affect memory, thinking, language, judgment and behavior and appear mainly from the age of 60.

In this article we will talk about Binswanger’s disease, a neurological disorder that causes vascular dementia. This type of dementia involves symptoms such as manic episodes and loss of inhibition, and accounts for 1 to 5% of total dementias.

    Binswanger disease: features

    Binswanger’s disease is a disease that causes vascular dementia, and which is characterized by atrophy of the cerebral white matter. It occurs as a result of vascular deficiency due to the existence of severe arteriosclerosis of the vessels supplying the mass of a deep white. Later we will see what arteriosclerosis is.

    This type of dementia involves the presence of heart attacks of two types: lacunar and cortical. In terms of prevalence, dementia due to Binswanger’s disease represents between 1 and 5% of total dementias.

      Risk factors

      The main risk factor for Binswanger’s disease is arterial hypertension (94% of patients with the disease are hypertensive), associated with age and severity of cerebral arteriosclerosis.

      In addition, dementia is often associated with the presence of type 2 diabetes, thrombocytosis, hyperlipidemia and coronary heart disease.

      symptoms

      Patients with dementia due to Binswanger’s disease, in most cases, they show their first symptoms between the ages of 60 and 70. There is no difference between women and men in terms of symptoms or chances of developing this disease.

      On the other hand, the life expectancy of patients is on average 5 years higher from diagnosis.

      The first three symptoms of Binswanger’s disease, which appear at an early stage and in 70% of cases, are as follows.

      1. Manic episodes

      Manic episodes are defined and persistent periods during which it appears an unusually high, expansive, or irritable mood. These are easy to detect episodes because the person feels particularly energetic, impulsive and euphoric, with ideas of grandeur. It is a psychological condition similar to hypomania.

      2. Amendments to the judgment

      The capacity for judgment is the cognition with which thought works; judging involves establishing relationships between two or more concepts. In everyday life, we use judgment or logic to understand things and analyze reality with common sense.

      Binswanger’s disease dementia patients have impaired judgment or logic, having difficulty in this type of reasoning or thinking.

      3. Loss of inhibition

      Inhibition or inhibitory control is the ability of humans to inhibit or control impulse responses (Or automatic), and generate responses mediated by attention and reasoning. It is a cognitive skill that allows you to anticipate, plan and set goals.

      In Binswanger’s disease, this ability is impaired and the patient loses this ability to plan and organize their behavior. Likewise, he begins to develop patterns of behavior characterized by impulsivity.

      4. Other symptoms

      Later, and as the disease progresses, abulias appear in the patient (lack of will or energy to do something or to move), as well as problems with orientation. The person begins to depend on others when performing activities of daily living (stroke).

      On the other hand, it can sometimes appear short- or long-term memory lossA characteristic that commonly appears in various types of dementia. Mental symptoms associated with other neurological symptoms may also appear, such as lack of motor coordination (when walking) or the presence of seizures.

      cause

      Dementia due to Binswanger’s disease is caused by vascular dysfunction. It is because of the existence of severe arteriosclerosis vessels that irrigate the substance of a deep white.

      Arteriosclerosis, on the other hand, is a condition where plaque builds up inside the arteriesPlaque is a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, this plaque hardens and narrows the arteries, restricting oxygen-rich blood flow.

      treatment

      Once dementia has been diagnosed with Binswanger’s disease, treatment is mainly symptomatic. On the other hand, hypertension is treated, until it is established in numbers in the normal (below 140/90 mm / Hg), which makes it possible to stabilize the symptoms.

      Some authors suggest reducing the hematocrit when it is above 45%; hematocrit is directly related to fibrinogen levels and blood viscosity.

      It is important to note that treatment for Binswanger’s disease should focus primarily on preventive treatment and control of hypertensionAs this is the main risk factor associated with the disease. In this way, the prevention and control of hypertension will help prevent cerebral arteriosclerosis which causes dementia.

      Bibliographical references:

      • Caplan LR (1995). Binswanger’s disease reviewed. Neurology, 45; 626-633.
      • Libon, D .; Price, C .; Davis Garrett, K .; Giovannetti, T. (2004). From Binswanger’s disease to leukoaraiosis: what we have learned about subcortical vascular dementia. The clinical neuropsychologist. 18 (1): 83-100.
      • Rodríguez, L. and Serra, I. (2002). Characterization by clinical imaging of Binswanger’s disease. Rev cubana med 41 (3), City of Havana. International Center for Neurological Restoration
      • Valence C. (2002). Comparative analysis of leucoaraiosis, Alzheimer’s disease, Binswanger’s disease and lacunar infarcts. Conventional and spectroscopic MRI study. Autonomous University of Barcelona. Department of Medicine

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